Provider Demographics
NPI:1164709036
Name:ABDUL EZELDIN M.D. P.A.
Entity Type:Organization
Organization Name:ABDUL EZELDIN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:EZELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-534-1726
Mailing Address - Street 1:1801 W 40TH AVE STE 5C
Mailing Address - Street 2:P. O BOX 1446
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6962
Mailing Address - Country:US
Mailing Address - Phone:870-534-1726
Mailing Address - Fax:870-534-0728
Practice Address - Street 1:1801 W 40TH AVE STE 5C
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6962
Practice Address - Country:US
Practice Address - Phone:870-534-1726
Practice Address - Fax:870-534-0728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARBE5718739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty